Many Arkansas docs say no to medical marijuana

But, according to people who contacted the Arkansas Times and medical marijuana supporter Melissa Fults, the $250 fee — which is the standard charge — is just too much, given that the patient must also pay $50 to the state to obtain a Medical Marijuana Registry Identification card based on the information provided by the doctor, and recertification must be done yearly, if not more frequently. Even if they can afford the fee, it’s not a certainty they can find a doctor who’ll agree to sign the form.

Nancy Young, 51, of Hot Springs is one of those people having difficulty on both counts. She’s on disability for post-traumatic stress disorder and other medical problems. Her psychiatrist in Little Rock would not sign the Medical Marijuana Physician Written Certification form; his group, Psychiatric Associates of Arkansas, had voted not to sign.

Here’s why: “Medical marijuana is baloney,” Psychiatric Associates’ Dr. Richard Owings said. “And the people who advocate for it know that.” The medical group’s Facebook page includes a link to a Reuters Health story that says there’s little evidence that marijuana alleviates pain or helps with PTSD.

Not surprisingly, Fults and users of marijuana who’ve gotten relief would disagree that medical marijuana is “baloney,” and want more doctors to help their patients obtain the drug by consenting to sign the form.

By signing, doctors verify they are licensed as medical doctors or osteopaths and that their patient has one or more of the 18 qualifying medical conditions listed on the form. The form is not a prescription, nor does it require the doctor to recommend medical marijuana as be appropriate for the condition, though an earlier version of the form would have. (The legislature amended that language out.) Doctors do not have to have had a previous relationship with a patient seeking certification, but must review the patient’s records to be able to attest to the fact that the patient has a qualifying condition. Qualifying diagnoses are cancer, glaucoma, HIV/AIDS, Hepatitis C, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Tourette’s syndrome, Crohn’s disease, ulcerative colitis, PTSD, severe arthritis, fibromyalgia, Alzheimer’s disease, cachexia (wasting), peripheral neuropathy, intractable pain that does not respond to ordinary medications or treatments for more than six months, severe nausea, seizures and severe and persistent muscle spasm, such as those characteristic of multiple sclerosis and others.

With the exception of Owings and another doctor who would only speak on condition of anonymity, doctors who aren’t signing the forms aren’t taking calls from the press inquiring why, either. Most specialists in rheumatology, ophthalmology, gastroenterology and cancer contacted by the Times declined to comment. One oncologist told the Times he was going to be extremely careful, that it would not be a first course of treatment, and that’s all he wanted to say besides, “Good luck with your story.”

The doctor who asked his name not be used said the forms were tantamount to giving a prescription for a substance that he says doctors have little experience with. “I don’t want to be monitored by the government,” the doctor said. “Also, we have so much to deal with as it is, with regulations, I don’t want to add a headache to everyday busy life.”

The doctor acknowledged that marijuana may alleviate nausea and stimulate appetite in patients who might otherwise waste, but said there are “better treatments with a scientific basis.”

Most of the doctors who are certifying patients are family practice and general practice doctors, and many of them are in Northwest Arkansas, though a list on the Arkansas Cannabis Industry Association website and information supplied by patients shows willing doctors cast all over Arkansas. There is one doctor in each of the following cities: Little Rock, Benton, Van Buren, Crossett, Jonesboro, Paragould, Blytheville, Ashdown, Eureka Springs, Bentonville, Fort Smith, Fayetteville and Mountain Home. Springdale has three. (The concentration in Northwest Arkansas likely reflects the retirement community there, though a cynic might wonder if it’s in anticipation of a number of University of Arkansas students beginning to complain of pain or stomach woes.) That does not mean that there are only 16 doctors certifying patients in Arkansas, but few physicians are openly advertising that they will sign the certification forms. As of Sept. 2, 863 applications for cards had been approved, according to the health department, which at one point said it expected 30,000.

Fults, who works with the Drug Policy Education Group and describes herself as a “62-year-old grandma goat farmer,” is distressed by the lack of participation by the state’s physicians. “We worked so hard trying not to label people as pot doctors,” but that’s what has happened, she said.

Fults figures some doctors are worried about not being reimbursed by insurance for the service, but suggests those that are could sign the forms during physicals and other checkups, which insurance will cover.

“Say you are my doctor and have been for the last 10 years, you know everything about my medical history. … So if you won’t write a certificate, I have to get a copy of my medical records, and then go to someone I know nothing about, never met and won’t see again until next year. To me that creates a problem, because you have a relationship with your doctor. You will not have a relationship with Dr. Tammy.”

Fults was referring to Dr. Tammy Hale Post, D.O., who, thanks to videos on Facebook and the cannabis industry website and through public relations firm outreach, is perhaps the best known doctor in Arkansas who advocates for marijuana and will sign certifications for the state’s medical marijuana cards.

Post charges $287 to patients who come to her seeking verification of their eligible illnesses. She gives a discount to veterans and low-income patients. Unlike many doctors, Post’s practice is all cash. Doctors affiliated with insurance companies can’t bill for the visit, since marijuana is still illegal. The federal Drug Enforcement Agency classifies it as a Schedule 1 illegal substance, along with heroin and other drugs.

“I think a lot of doctors don’t understand” that by signing the form they are neither prescribing marijuana nor advocating its use, Post said. The Springdale doctor, who is writing a book on medical marijuana, noted that the plant has been used “since the dawn of time” as a medicine.

A native of Mountain Home, Post said she did not use pot growing up; she believed it to be a gateway drug. “I was totally against it.” But she began to be “passionate” about the drug because of benefits she believes it offers for the treatment of seizures. “My father had a brain tumor that caused a seizure disorder. … He would have 300 [seizures] a day; his life was controlled by them.” His medicines not only did not control the seizures, she said, their side effect was bone cancer. He died when she was 19. She doesn’t know if it could have helped her father, but it spurred her to study the plant.